Chapter 5:

Tobacco 101

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USA CEOs of cigarette companies testify before Congress that it is their opinion that nicotine is not addictive


USA Surgeons General’s Report determines that smoking causes lung cancer in men


USA Reader’s Digest publishes Cancer by the Carton article


USA Major report on smoking (Wynder and Graham)


USA First link between smoking and lung cancer (Ochsner)


USA Birth of the “modern” cigarette:
RJ Reynolds introduces the Camel brand


USA Invention of cigarette machine


USA First federal tobacco tax introduced to help finance Civil War


Canada Tobacco first grown commercially


Americas Tobacco first grown commercially


Santo Domingo European settlers begin tobacco cultivation


Cuba Columbus discovers tobacco smoking and takes it to Europe

Circa 1BC

Indigenous Americans begin smoking

6000 BC

Americas First cultivation of the tobacco plant and using tobacco enemas

World Health Organization. (n.d.). The History of Tobacco [image]. Retrieved September 17, 2020, from


Tobacco Persona Sketch


“Insecure follower. Has menial boring job. Probably leads fairly dull existence. Emotionally insecure. Problems with self-esteem. Passive-aggressive. Lacks inner resources. Grooming not a strong priority. Lower standard of living. Group conformist. Non-thinking. Not into ideas. Insecure follower.”1,2

1. Fact 260. (2019). Retrieved September 22, 2020, from

2. Hunter, C.S. (1989) “Marketing research report. Inner city black creative exploratory.” Truth Tobacco Industry Documents.

All of these terms found in big tobacco’s files were used to delineate different groups of potential customers for their products.

Research shows that exposure to TV shows, movies and ads with tobacco more than doubles an individual’s chances to start smoking.1,2 In fact, the Surgeon General’s report found that if current marketing rates continue, 5.6 million youth alive today are expected to die from tobacco related diseases. If all future movies that include smoking are given an R rating, it is expected that change would reduce the number of teen smokers by 18%, averting around 1 million tobacco related deaths among children and teens alive today.1

1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (USDHHS). (2014). The Health Consequences of smoking - 50 years of progress: A report of the surgeon general. Atlanta, GA:  National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

2. Charlesworth, A., & Glantz, S. A. (2005). Smoking in the Movies Increases Adolescent Smoking: A Review. Pediatrics, 116(6), 1516–1528.


Women are a huge target for the tobacco industry. In fact, until 2007, in an effort to attract young girls, Camel sold pink and teal packaged cigarettes. Tobacco companies continue to make ads and brands specifically targeted towards women.

Pierce, J. P., Messer, K., James, L. E., White, M. M., Kealey, S., Vallone, D. M., & Healton, C. G. (2010). Camel No. 9 cigarette-marketing campaign targeted young teenage girls. Pediatrics, 125(4), 619–626.

According to the CDC, “marketing toward women is dominated by themes of social desirability, empowerment, and independence.”1 For example, these ads focus on skinny, fit, and athletic models.women's magazine covers depicting smoking Tobacco marketing towards women also focuses on physical appearance, how smoking can make them thin, and oftentimes how smoking can help them attract men.2,3

1. U.S. Department of Health and Human Services. (2001). Women and Smoking: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

2. Boyd, C. J., Boyd, T. C., & Cash, J. L. (1999). Why is Virginia Slim? Women and Cigarette Advertising. International Quarterly of Community Health Education, 19(1), 19–31.

3. Zucker, A. N., Harrell, Z. A., Miner-Rubino, K., Stewart, A. J., Pomerleau, C. S., & Boyd, C. J. (2001). Smoking in College Women: The Role of Thinness Pressures, Media Exposure, and Critical Consciousness. Psychology of Women Quarterly, 25(3), 233–241.

(images) Rutgers Center for Tobacco Studies. (n.d.). Trinkets and Trash: Artifacts of the Tobacco Epidemic. Retrieved September 17, 2020, from

After big tobacco recognized that smoking as an “upscale and mainstream behavior” was declining, they planned to target “a population that is increasingly blue collar, ethnic, and less educated.”

Siahpush, M., Singh, G. K., Jones, P. R., & Timsina, L. R. (2010). Racial/ethnic and socioeconomic variations in duration of smoking: Results from 2003, 2006 and 2007 Tobacco Use Supplement of the Current Population Survey. Journal of Public Health (Oxford, England), 32(2), 210–218.

Big Tobacco Targets:
Ashtrays representing the social groups that Big Tobacco targets and attempts to manipulate.

Hispanics and American Indians/Alaska Natives through the promotion of certain cigarette brands, such as Dorado, Rio, and American Spirit.1,2

African American communities by using “urban culture and language to promote menthol cigarettes,” having “tobacco-sponsored hip-hop bar nights with samples of specialty menthol cigarettes,” and “targeted direct-mail promotions.”1

Asian Americans by sponsoring Vietnamese and Chinese New Year festivals, sponsoring Asian/Pacific American Heritage Month, donating to community organizations, and supporting Asian American businesses.1,2

The LGBTQ community by using ads featuring members of the LGBTQ community and using “pride” in their campaigns.3

People with mental health issues by (in the past) giving free cigarettes to psychiatric facilities. The tobacco industry makes $37 billion a year selling products to this population.4

1. National Cancer Institute. (2008). The Role of the Media in Promoting and Reducing Tobacco Use. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute.

2. U.S. Department of Health and Human Services. (1998). Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

3. Kulke, C. (2015, July 16). Why Are LGBTQ Americans 33 Percent More Likely to Smoke Than Straight People? Slate Magazine.

4. Maloney, J., & Chaudhuri, S. (2017, April 23). Against All Odds, the U.S. Tobacco Industry Is Rolling in Money. Wall Street Journal.

What is the legal age of sale for all tobacco products in the U.S.?
What is the legal age of sale for all tobacco products in the U.S.?




The legal sale age for tobacco in the U.S. was raised from 18 to 21 in 2019. 

To help delay the initiation of tobacco use, the President signed legislation on December 20, 2019, raising the minimum age of sale for tobacco products in the U.S from 18 to 21.



“…It is now illegal for a retailer to sell any tobacco product…to anyone under 21. The new federal minimum age of sale applies to all retail establishments and persons with no exceptions.”

U.S. Food & Drug Administration (2020, February 12). Tobacco 21. Retrieved from


Tobacco products include, but are not limited to: cigarettes, smokeless tobacco, hookah, cigars, pipes,
e-cigarettes, vapes, and e-liquids

U.S. Food & Drug Administration (2020, February 12). Tobacco 21. Retrieved from


Tobacco 21 (T21)

T21 is a law that raised the legal minimum age of sale for tobacco in the U.S. from 18 to 21. However, in Texas, anyone under the age of 21 could be penalized for purchasing tobacco. It is illegal for minors (under 21) in Texas to purchase any type of tobacco product, and it is illegal for retailers in Texas to sell tobacco to anyone under the age of 21.

Click the myths to reveal the realities.

  Click the myths to reveal the realities.

There will be a grace period for compliance after T21 is passed, so it will not go into effect immediately.


T21 went into immediate effect after it was passed.1


T21 does not apply to active duty military personnel, military veterans, or people born on or before August 31, 2001.


Yes and no. Based on the current federal legislation, there are no exemptions for active duty military personnel or military veterans under the age of 21. However, Texas law does provide exemptions to people born on or before August 31, 2001 and to people in the U.S. or state military forces who are under 21. 2


Raising the minimum age of sale for tobacco to 21 won’t really have an effect on tobacco use among youth and young adults.


(1) T21 could prevent 223,000 deaths among people born between 2000-2019.3
(2) T21 could help reduce cancer deaths by 50,000.3
(3) It is projected that the T21 law will decrease the use of tobacco products by 12% and prevent 223,000 of premature deaths.4


No one is going to enforce T21.


The FDA will conduct compliance inspections of tobacco product retailers.2

1. Hill, K. (2020, January 14). The New Federal Tobacco-21 Law: What it Means for State, Local, and Tribal Governments.

2. U.S. Food & Drug Administration (2020, February 12). Tobacco 21. Retrieved from

3. National Academies Press. (2015). Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (K. Stratton & R. J. Bonnie, Eds.). National Academies Press (US).

4. Marynak, K., Mahoney, M., Williams, K. S., Tynan, M. A., Reimels, E., & King, B. (2020). State and Territorial Laws Prohibiting Sales of Tobacco Products to Persons Aged 21 Years—United States, December 20, 2019. MMWR. Morbidity and Mortality Weekly Report, 69.

FDA Flavor Ban

Newspaper-- headline says FDA finalized enforcement policy on ENDs flavorsThe United States has never seen an epidemic of substance use arise as quickly as our current epidemic of youth use of e-cigarettes… By prioritizing enforcement against the products that are most widely used by children, our action today seeks to strike the right public health balance by maintaining e-cigarettes as a potential off-ramp for adults using combustible tobacco while ensuring these products don’t provide an on-ramp to nicotine addiction for our youth.” – Alex Azar Secretary of Health and Human Services

U.S. Food and Drug Administration. (2020, January 2). FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint [press release].

2019 National Youth Tobacco
Survey Results

Middle and high school students who:

Graph showing 1 million Used e-cigarettes daily, 1.6 million Used e-cigarettes for 20+ days in a 30-day period, and more than 5 million Used e-cigarettes in the last 30 days.


Cullen, K. A., Gentzke, A. S., Sawdey, M. D., Chang, J. T., Anic, G. M., Wang, T. W., Creamer, M. R., Jamal, A., Ambrose, B. K., & King, B. A. (2019). E-Cigarette Use Among Youth in the United States, 2019. JAMA, 322(21), 2095–2103.

Youth who use e-cigarettes have a high risk for nicotine addiction and are more likely to try traditional cigarettes in the future.1

Of all young adults and youth who have used tobacco, 81% started with a flavored product.2

Researchers have been able to identify over 15,500  distinctive e-cigarette flavors accessible online.3

Fruit and mint flavors are more popular to youth than tobacco and menthol flavors.4


1. Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., ... & Spindle, T. R. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA pediatrics, 171(8), 788-797.

2. Villanti, A. C., Johnson, A. L., Ambrose, B. K., Cummings, K. M., Stanton, C. A., Rose, S. W., Feirman, S. P., Tworek, C., Glasser, A. M., Pearson, J. L., Cohn, A. M., Conway, K. P., Niaura, R. S., Bansal-Travers, M., & Hyland, A. (2017). Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013–2014). American Journal of Preventive Medicine, 53(2), 139–151.

3. Zhu, S-H, et al., “Evolution of Electronic Cigarette Brands from 2013-2014 to 2016-2017: Analysis of Brand Websites,” Journal of Medical Internet Research, 20(3), published online March 12, 2018. 20

4. Leventhal, A. M., Miech, R., Barrington-Trimis, J., Johnston, L. D., O’Malley, P. M., & Patrick, M. E. (2019). Flavors of e-Cigarettes Used by Youths in the United States. JAMA, 322(21), 2132–2134.

FDA Flavor Ban

August 8, 2016 – ALL e-cigarettes and ENDS products require premarket authorization requirements in the FD&C Act (Federal Food, Drug, and Cosmetic Act).


Currently, all ENDS products on the market are technically illegally marketed, since none of them have been authorized by the FDA.


“After May 12, 2020, the FDA intends to also prioritize enforcement against any ENDS products that continue to be sold and for which the manufacturers have not submitted a premarket application.”

U.S. Food and Drug Administration. (2020, January 2). FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint [press release].

FDA Flavor Ban

Approved or Unapproved Flavors?

Mint and Tobacco are the only flavors that are not banned.




COVID-19 ATTACKS THE LUNGS and poses a serious threat to people who vape or smoke tobacco, because vaping and smoking compromises lung function.1





Individuals with compromised lung function or a history of lung disease related to smoking, have a high risk for serious complications of COVID-19.1


Additionally, aerosols from e-cigarettes and vapes harm lung cells and reduce the lungs’ ability to respond to infections.2

1. Vardavas, C. I., & Nikitara, K. (2020). COVID-19 and smoking: A systematic review of the evidence. Tobacco Induced Diseases, 18(March).

2. Madison, M. C., Landers, C. T., Gu, B.-H., Chang, C.-Y., Tung, H.-Y., You, R., Hong, M. J., Baghaei, N., Song, L.-Z., Porter, P., Putluri, N., Salas, R., Gilbert, B. E., Levental, I., Campen, M. J., Corry, D. B., & Kheradmand, F. (2020). Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine. The Journal of Clinical Investigation, 129(10), 4290–4304.




Individuals can decrease their risk of respiratory infections by refraining from smoking or vaping.


There’s still so much more for scientists to learn about COVID-19. While we’re at home, we can all protect our lungs by picking up some healthy habits instead of smoking or vaping.

Park, J.-E., Jung, S., Kim, A., & Park, J.-E. (2018). MERS transmission and risk factors: A systematic review. BMC Public Health, 18(1), 574.

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